Discontinuities in clinical information systems pose a large problem for everyday clinical practice. Although care for patients spans outpatient and inpatient settings, clinical information systems, until now, focus on either outpatient or inpatient but not both. We aim to demonstrate the value of an integrated outpatient and inpatient health information system to improve quality of health care and patient safety. Pregnant women inevitably transition across inpatient and outpatient settings in a matter of months, making this an ideal situation to test whether integration can makes a difference. We have chosen a common and potentially life threatening condition to demonstrate our point - group B streptococcus. The specific aims of this proposal are to: - Test whether a system that transmits GBS results with inpatient alerts improves adherence to evidence-based treatment guidelines for women who are GBS positive (quality of care). - Demonstrate whether the above intervention reduces inappropriate antibiotic use in women who are GBS negative (patient safety). - Demonstrate the value of an electronic alert system to increase GBS screening in the outpatient setting. - Perform a cost-benefit analysis to assess the impact of implementing HIT. These data will increase our knowledge about the value of integrated HIT systems to produce measurable improvements in safety and quality. The findings, though applied specifically for OB, can be applied to many areas of medicine and surgery. The findings will provide inpatient and outpatient HIT stakeholders needed information to make important decisions.